The general medical and surgical hospital located in Glendale, Ariz., implemented Cerner Clairvia Outcomes Driven Acuity™ and Immediately, the system identified that some of the patients’ acuities did not fit the level of care for those units.
Banner Thunderbird Medical Center (BTMC), a general medical and surgical hospital located in Glendale, Ariz., implemented Cerner Clairvia Outcomes Driven Acuity in September 2013. Immediately, the system identified that some of the patients’ acuities in BTMC’s Intensive Care Unit (ICU) and Progressive Care Unit (PCU) did not fit the level of care for those units.
“Data confirmed what we thought— that some of these patients required a lower level of care than ICU, and some required a higher level of care than PCU.” said Joyce Rudders, RN, MSN RN, director of Critical Care, Intermediate Care and Progressive Care Services at BTMC.
Cerner Clairvia’s℠ workforce management solutions enable health care organizations to align labor resources with their strategic goals and patient needs. The Outcomes Driven Acuity solution aggregates data to support staffing decisions by leveraging documentation in the EHR.
“Most care models were designed decades ago; our patient population has changed,” said Karin Toci, RN, MSN, CPHQ, chief nursing officer, BTMC. “Clairvia® is going to give us the science of what the care model needs to look like in the near future, science to let us know how to remodel our staffing based upon the needs of the patient.”
Nurse leaders at BTMC utilized the information provided by Clairvia to determine that an alternate level of care would be more appropriate for certain patient populations based on acuity data. This alternate level of care, named Intermediate Care Unit (IMCU), provides a dedicated unit that safely cares for patients who require more care than a traditional progressive care unit. This unit also accommodates the patients who do not meet ICU criteria, but require more care hours that are provided on a medical-surgical unit.
“We used Cerner Clairvia acuity scores to determine what types of patients would be appropriate for the IMCU,” said Rudders. “With this information we then met with system leaders and physicians to create policies and guidelines for the IMCU. We also created a new level of education and training for the IMCU nurses.”
In May 2015, BTMC opened a 20-bed IMCU. Nine of the 20 rooms were designed identically to the current ICU rooms, including telemetry and bedside monitoring.
BTMC’s decision, supported by Clairvia data, to open the IMCU is “helping get patients in the right level of care,” said Toci. Survey results showed that 85 percent of IMCU patients would recommend the hospital to a family member, demonstrating the new unit’s positive impact on patient experience or quality of care.
After opening the IMCU, there was a 68 percent reduction in reported patients in holding areas outside of the ICU due to lack of beds, according to data recorded by charge nurses on end of shift reports.
Average acuity scores have gone up in the ICU since the IMCU opened. “This is exactly what we would expect, as our patients with the highest care needs remained in the ICU while lower acuity patients were shifted to the IMCU,” said Rudders.
BTMC has also measured a substantial financial benefit related to labor costs. Based on the average of total cases, it is estimated that adding the IMCU resulted in a savings of $156,000 in 2015, and is estimated to save approximately $810,000 in 2016. These numbers are based on the average cost of total cases in the ICU versus the IMCU.
“Clairvia is shining a light on how we look at staffing for budgetary reasons. It helps us see the changing needs of our populations. Banner’s goal is to figure out how to redesign staffing models to meet our patients’ new needs and put this information together to affect the 2018 budget,” said Toci.